A 6 y/o female is seen by her pediatrician because her mother became concerned w

Question

A 6 y/o female is seen by her pediatrician because her mother became concerned with her small stature and low weight. The physician notes that she is in the 18th percentile in height and 23rd percentile in weight. The mother states that the Px is thirsty ‘all the time’ and urinates constantly. Blood and urine tests show that the Px has hypokalemia, proteinuria, hypophosphatemia, glycosuria, and a blood HCO3 level of 14 mEq/L.   A bone density scan indicates that the Px has osteomalacia. Neither parent has any genetic concerns. When the physician inquired about the child’s eating habits and environment, the mother states that she has a normal diet that includes all the food groups, but she always puts things in her mouth. The family lives in a section of the city that was built in the 1930’s.

From these data, what part of the nephon was affected by this pathology? Explain the mechanisms. (use cellular mechanisms and diagrams)

What is the diagnosis?

Explanation / Answer

Affected part of nephron:

The first part of nephron is the glomerulus. It is a filtration membrane through which blood components are filtered. The filtrate contains salts, water, glucose and urea. This filtrate should not contain protein. But this patient is having proteinuria i.e. protein is present in urine. So, the glomerulus of the nephron is affected in this patient.

Diagnosis of this disease is chronic glomerulonephritis.

Cellular mechanism:

Generally this disease occurs when the kidneys is exposed to drugs for a long time; drugs can be antibiotics like rifampicin. This results in a kidney injury. If the injury occurs in glomerulus, then glomerulonephritis occurs.

When the antibiotic is taken orally, it travels through the brush border of the intestine into the blood. Here is comes into the afferent arteriole. The afferent arteriole brings blood to the kidney nephrons. Blood is pumped through the arteriole with every blood circulation. Prolonged entry of drug into the glomerulus will result into inflammation of glomerulus.

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